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<meta name="DC.Title" content="Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1882" />
<meta name="DC.Date" content="2010-04-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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Indicates open access to non-subscribers at www.ajnr.org" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Endovascular TVE for DCCF is used for curative purposes, but serious complications can be caused with inadequate embolization. Our aim was to report clinical characteristics, angiographic findings, and results of endovascular TVE in patients presenting with DCCF.

MATERIALS AND METHODS: We performed a retrospective analysis of 44 consecutive patients with DCCF treated by TVE. Approach routes, angiographic results, clinical outcomes, and complications were assessed.

RESULTS: An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81.6% of patients. A minor residual shunt remained in 13.6% of patients, while a significant shunt remained in 4.5%. In 4 patients, add-on management with transarterial embolization was useful, and in 2 patients with residual shunt, radiosurgery was used. With long-term follow-up (6–40 months), we encountered recanalization/recurrence in 4 patients (9.1%). Complications were seen in the form of permanent morbidity in 3 patients (7%) and transient morbidity in 6 patients (14%).

CONCLUSIONS: For endovascular treatment of DCCF, a transvenous approach was effective in most of our patients; however, some adverse effects were encountered. If AV shunts remain after transvenous treatment, additional modalities must be considered.

AV
:   arteriovenous
B
:   Barrow type B
Bilat.
:   bilateral
CN
:   cranial nerve
CS
:   cavernous sinus
D
:   Barrow type D
DCCF
:   dural carotid-cavernous fistula
ECA
:   external carotid artery
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IPS
:   inferior petrosal sinus
Lt.
:   left
Rt.
:   right
SOV
:   superior ophthalmic vein
SPS
:   superior petrosal sinus
TVE
:   transvenous embolization" />
<meta name="DC.Contributor" content="K. Yoshida" />
<meta name="DC.Contributor" content="M. Melake" />
<meta name="DC.Contributor" content="H. Oishi" />
<meta name="DC.Contributor" content="M. Yamamoto" />
<meta name="DC.Contributor" content="H. Arai" />
<meta name="article:published_time" content="2010-04-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Endovascular TVE for DCCF is used for curative purposes, but serious complications can be caused with inadequate embolization. Our aim was to report clinical characteristics, angiographic findings, and results of endovascular TVE in patients presenting with DCCF.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We performed a retrospective analysis of 44 consecutive patients with DCCF treated by TVE. Approach routes, angiographic results, clinical outcomes, and complications were assessed.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81.6% of patients. A minor residual shunt remained in 13.6% of patients, while a significant shunt remained in 4.5%. In 4 patients, add-on management with transarterial embolization was useful, and in 2 patients with residual shunt, radiosurgery was used. With long-term follow-up (6–40 months), we encountered recanalization/recurrence in 4 patients (9.1%). Complications were seen in the form of permanent morbidity in 3 patients (7%) and transient morbidity in 6 patients (14%).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;For endovascular treatment of DCCF, a transvenous approach was effective in most of our patients; however, some adverse effects were encountered. If AV shunts remain after transvenous treatment, additional modalities must be considered.&lt;/p&gt;" />
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<meta name="twitter:title" content="Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Endovascular TVE for DCCF is used for curative purposes, but serious complications can be caused with inadequate embolization. Our aim was to report clinical characteristics, angiographic findings, and results of endovascular TVE in patients presenting with DCCF.

MATERIALS AND METHODS: We performed a retrospective analysis of 44 consecutive patients with DCCF treated by TVE. Approach routes, angiographic results, clinical outcomes, and complications were assessed.

RESULTS: An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81.6% of patients. A minor residual shunt remained in 13.6% of patients, while a significant shunt remained in 4.5%. In 4 patients, add-on management with transarterial embolization was useful, and in 2 patients with residual shunt, radiosurgery was used. With long-term follow-up (6–40 months), we encountered recanalization/recurrence in 4 patients (9.1%). Complications were seen in the form of permanent morbidity in 3 patients (7%) and transient morbidity in 6 patients (14%).

CONCLUSIONS: For endovascular treatment of DCCF, a transvenous approach was effective in most of our patients; however, some adverse effects were encountered. If AV shunts remain after transvenous treatment, additional modalities must be considered.

AV
:   arteriovenous
B
:   Barrow type B
Bilat.
:   bilateral
CN
:   cranial nerve
CS
:   cavernous sinus
D
:   Barrow type D
DCCF
:   dural carotid-cavernous fistula
ECA
:   external carotid artery
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IPS
:   inferior petrosal sinus
Lt.
:   left
Rt.
:   right
SOV
:   superior ophthalmic vein
SPS
:   superior petrosal sinus
TVE
:   transvenous embolization" />
<meta name="og-title" property="og:title" content="Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/4/651" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Endovascular TVE for DCCF is used for curative purposes, but serious complications can be caused with inadequate embolization. Our aim was to report clinical characteristics, angiographic findings, and results of endovascular TVE in patients presenting with DCCF.

MATERIALS AND METHODS: We performed a retrospective analysis of 44 consecutive patients with DCCF treated by TVE. Approach routes, angiographic results, clinical outcomes, and complications were assessed.

RESULTS: An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81.6% of patients. A minor residual shunt remained in 13.6% of patients, while a significant shunt remained in 4.5%. In 4 patients, add-on management with transarterial embolization was useful, and in 2 patients with residual shunt, radiosurgery was used. With long-term follow-up (6–40 months), we encountered recanalization/recurrence in 4 patients (9.1%). Complications were seen in the form of permanent morbidity in 3 patients (7%) and transient morbidity in 6 patients (14%).

CONCLUSIONS: For endovascular treatment of DCCF, a transvenous approach was effective in most of our patients; however, some adverse effects were encountered. If AV shunts remain after transvenous treatment, additional modalities must be considered.

AV
:   arteriovenous
B
:   Barrow type B
Bilat.
:   bilateral
CN
:   cranial nerve
CS
:   cavernous sinus
D
:   Barrow type D
DCCF
:   dural carotid-cavernous fistula
ECA
:   external carotid artery
ICA
:   internal carotid artery
ICH
:   intracerebral hemorrhage
IPS
:   inferior petrosal sinus
Lt.
:   left
Rt.
:   right
SOV
:   superior ophthalmic vein
SPS
:   superior petrosal sinus
TVE
:   transvenous embolization" />
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      <h1 class="highwire-cite-title" id="page-title">Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K. Yoshida</span>, <span class="highwire-citation-author" data-delta="1">M. Melake</span>, <span class="highwire-citation-author" data-delta="2">H. Oishi</span>, <span class="highwire-citation-author" data-delta="3">M. Yamamoto</span> and <span class="highwire-citation-author" data-delta="4">H. Arai</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">April 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(4) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">651-655; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A1882 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9633--61640822755" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K. Yoshida </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BYoshida%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yoshida%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK.%2BYoshida%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Melake </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BMelake%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Melake%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BMelake%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">H. Oishi </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BOishi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Oishi%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.%2BOishi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">M. Yamamoto </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BYamamoto%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yamamoto%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM.%2BYamamoto%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">H. Arai </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BArai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Arai%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.%2BArai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Endovascular TVE for DCCF is used for curative purposes, but serious complications can be caused with inadequate embolization. Our aim was to report clinical characteristics, angiographic findings, and results of endovascular TVE in patients presenting with DCCF.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> We performed a retrospective analysis of 44 consecutive patients with DCCF treated by TVE. Approach routes, angiographic results, clinical outcomes, and complications were assessed.</p>
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<p id="p-4"><strong>RESULTS:</strong> An approach via the internal jugular vein and inferior petrosal sinus was possible in 90% of patients, with complete occlusion of the fistula in 81.6% of patients. A minor residual shunt remained in 13.6% of patients, while a significant shunt remained in 4.5%. In 4 patients, add-on management with transarterial embolization was useful, and in 2 patients with residual shunt, radiosurgery was used. With long-term follow-up (6–40 months), we encountered recanalization/recurrence in 4 patients (9.1%). Complications were seen in the form of permanent morbidity in 3 patients (7%) and transient morbidity in 6 patients (14%).</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> For endovascular treatment of DCCF, a transvenous approach was effective in most of our patients; however, some adverse effects were encountered. If AV shunts remain after transvenous treatment, additional modalities must be considered.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">AV<span class="def-item-dt-sep"></span></dt><dd>arteriovenous<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">B<span class="def-item-dt-sep"></span></dt><dd>Barrow type B<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">Bilat.<span class="def-item-dt-sep"></span></dt><dd>bilateral<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">CN<span class="def-item-dt-sep"></span></dt><dd>cranial nerve<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">CS<span class="def-item-dt-sep"></span></dt><dd>cavernous sinus<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">D<span class="def-item-dt-sep"></span></dt><dd>Barrow type D<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">DCCF<span class="def-item-dt-sep"></span></dt><dd>dural carotid-cavernous fistula<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">ECA<span class="def-item-dt-sep"></span></dt><dd>external carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">ICH<span class="def-item-dt-sep"></span></dt><dd>intracerebral hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">IPS<span class="def-item-dt-sep"></span></dt><dd>inferior petrosal sinus<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">Lt.<span class="def-item-dt-sep"></span></dt><dd>left<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">Rt.<span class="def-item-dt-sep"></span></dt><dd>right<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">SOV<span class="def-item-dt-sep"></span></dt><dd>superior ophthalmic vein<span class="def-item-dd-sep"></span></dd><dt id="def-item-15">SPS<span class="def-item-dt-sep"></span></dt><dd>superior petrosal sinus<span class="def-item-dd-sep"></span></dd><dt id="def-item-16">TVE<span class="def-item-dt-sep"></span></dt><dd>transvenous embolization</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/4/651.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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      <div class="highwire-cite-title">Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients</div>  
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      <div class="highwire-cite-title">Transvenous Embolization of Dural Carotid Cavernous Fistulas: A Series of 44 Consecutive Patients</div>  
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